Augmentation of the calfs is most consistently done with a synthetic implant. Most patients who seek calf augmentation are typically body builder types, those born with very thin calfs who have been unable to build them up, or sosmeone with significant calf asymmetry. Despite an implant’s predictable improvement in the size and shape of the calfs, calf implants are not without problems. Implant placement into and on top of the calf muscles makes recovery uncomfortable and having to stand and walk around early on afetr surgery makes it possible for the implant to shift, develop a fluid collections (seroma) or possibly even get infected.
Because of these implant concerns, the alternative treatment of fat injections or free fat grafting has emerged. A recent article in Plastic and Reconstructive Surgery presents a patient series using fat injections for calf augmentation. Their reported experience is encouraging. Fat grafting to the calfs has numerous potential advantages such as the elimination of the need for a synthetic implant, the use of a patient’s own body tissues, an easier recovery with few limitations, and a very low risk of bleeding or infection. Such advantages over an implant gives serious thought to its use.
All of these advantages of free fat fat grafting is counterbalanced by one significant disadvantage….an unpredictability of after surgery shape and size. How much fat survives and is retained is widely variable. No plastic surgeon can guarantee or predict with 100% accuracy how much fat will survive on a consistent basis. The article reports using 75 – 125cc per calf with good volume retention.The burning question through the past several decades is…how to make fat grafting work better. The injection technique is, of course, important but is only half of the answer. How the fat is prepared after harvest in the oeprating room is the other half. Everyone agrees that concentration is very important after harvest. This is the mechanical process of removing the liquids from the more solid fat components. Whether this is done by a centrifuge or passing the fat aspirate through a strainer or sieve are two methods of which one has not been proven to be better than the other. Additives to the fat are theoretically appealing but there is no universal magical additive. Currently, I add platelet-rich plasma (PRP) to the concentrated fat prior to injection. Whether this aids fat survival is not proven but since it is a product of the patient, there is no risk in so doing. PRP is a concentrate of a patient’s own blood done at the time of surgery. While there is no standardized amount of PRP to add to fat, I would envision adding 3cc of PRP per calf graft site.
Having done a few cases of calf augmentation with fat injections, the technical aspect of this approach is straightforward. Careful marking of the patient while standing beforehand is critical to get the proper areas augmented. Like all fat injection surgeries, the patient must accept that the amount of fat that will survive is unpredictable. It may require more than one injection session to obtain the best result. Most fat grafting methods will not achieve the degree of volume enhancement that a calf implant will. In reviewing the before and after photos from the above mentioned article, that observation seems to be true.
Dr. Barry Eppley

Indianapolis, Indiana

Calf Implants and Augmentation

The use of calf implants to give the lower leg more shape is not as uncommon as you think. There are many different reasons why someone wants calf implants; from the bodybuilder who can’t get the calfs big enough compared to the rest of the thighs, a birth defect or surgically-induced problem where one calf is much smaller than the other (asymmetry), or someone that just has extremely thin calfs since they were born. (stick legs) Calf muscles are some of the hardest muscles to build up by exercise and are extremely resistent to getting bigger without a herculean effort at weight-lifting.

Calf implant surgery is based on two important concepts; the placement of calf implants to simulate the two calf muscles on both sides of the calf (although not every patient requires two implants per calf) and the use of rubbery (semisolid, not liquid) silicone implants that come in a variety of sizes and shapes. The location and size of the implants should be determined in the office in advance of surgery by measurements.

Calf implants are placed through an incision in the back of the knee and pockets into which the implants are placed developed within the calf muscles. After which, the implants are slipped into place. The surgery does not take long but you need to be prepared for some recovery after surgery. While the procedure is done as an outpatient, calf implant surgery can be quite painful and full recovery is going to require some time. Be prepared to do the following after calf implant surgery; plan to take two weeks off work, rest your legs and elevate your ankles for several days after surgery and use crutches to get around, plan to walk in heeled shoes for a while (walking flat footed initially is very uncomfortable), walk with knees slightly bent, don’t work out for 4 to 6 weeks after surgery, and avoid running for two to three months after surgery. The biggest complication of calf implant surgery is the implants shifting from their place or a fluid collection occurring around them (seroma). Both of these problems are caused by too much calf activity after surgery! Also, expect stiff and sore calves for a month or so after surgery.

Calf implants can definitely give a better shape and a more muscular appearance to the lower legs but you have to be prepared for the recovery period. Calf implants take the longest to recover from any other body implant surgery in my experience. (pectoral, biceps, triceps, buttocks)

Dr Barry Eppley

Indianapolis, Indianapolis